Now, a top U.S. panel of health experts has published recommendations that aim to limit people’s use of daily aspirin to prevent a first heart attack or stroke.
Here’s what you need to know about the finalized guideline changes, aspirin’s benefits and risks, and why it’s important to talk to your doctor to find out if taking it daily is right for you.
Where Do the Experts Stand on Daily Aspirin?
The recommendations come from an independent panel of experts in disease prevention and evidence-based medicine called the U.S. Preventive Services Task Force (USPSTF). The group has revamped its 2016 guidelines on aspirin after reviewing newer studies. In 2021, it released a draft version of proposed changes and made them available for public comment.
Now, the task force has published its final recommendations:
- People 40 to 59 years old who are at higher risk for heart disease or stroke and don’t have a history of either condition should talk to their doctor about whether they should start taking aspirin as preventive step.
- People 60 and older shouldn’t start taking aspirin to prevent a first heart attack or stroke. The task force says the risk of internal bleeding due to aspirin, which rises with age and can be life-threatening, cancels out the benefits of preventing heart problems in people 60 and older.
These recommendations aren’t meant for everyone, the USPSTF says. Ask your doctor what you should do if you:
- Already have heart disease
- Have had a stroke
- Are already taking aspirin
If you’re already taking aspirin because you’ve had a heart attack or stroke, don’t stop taking it unless your doctor tells you to, the task force says.
How Does Aspirin Help the Heart?
It eases inflammation. Plaque may be more likely to cause a heart attack or stroke if it’s inflamed. Aspirin blocks an enzyme called cyclooxygenase. That makes your body less likely to produce chemicals that can help cause inflammation.
It helps prevent blood clots. Some chemicals in the blood trigger events that cause blood clots. When aspirin stops those chemicals, it helps slow the formation of the clots. That’s important because they can clog the arteries that bring blood to heart muscle and the brain, which increases your risk of heart attack and stroke.
It might reduce your risk of death. A low-dose aspirin might be considered to prevent a first heart attack and stroke in a select group of adults between 40-59 who aren't at increased risk of bleeding.
Who Could Benefit?
- People with coronary artery disease or atherosclerosis (hardening of the arteries)
- Those who have had a heart attack
- People who have had bypass surgery, angioplasty, or stent placement to treat heart disease
- Folks who have had a transient ischemic attack (TIA) or ischemic stroke
If you have symptoms of a heart attack, call 911 right away. If you don’t have an aspirin allergy, EMS personnel may ask you to chew one standard, 325-milligram aspirin slowly. It's especially effective if you take it within 30 minutes of your first symptoms.
If you’re at risk for heart disease, carrying an aspirin with you in case of emergency might be a lifesaving technique.
What Are the Risks?
What Are the Benefits?
- Aspirin can greatly reduce the damage to your heart during a heart attack.
- It can help prevent future heart problems after a heart attack.
- It can reduce your risk of another stroke.
Talk to your doctor about the benefits and risks of aspirin therapy before you begin a regular regimen.
How Much Should I Take?
Research says between 80 milligrams and 160 milligrams per day. This is less than half of the standard 325-milligram aspirin most people are prescribed.
Many studies show the lower dose works just as well as the higher dose. It also drops your risk of internal bleeding. A baby aspirin contains 81 milligrams. There are other lower-dose adult aspirins available.
Check with your doctor first to find out what dose is right for you.
How Should I Take It?
First, tell your doctor if you are allergic to aspirin, ibuprofen, or naproxen. If you get the go-ahead to start an aspirin routine, then:
- Don’t take it on an empty stomach. Take aspirin with a full glass of water with meals or after meals to prevent stomach upset.
- Don’t break, crush, or chew extended-release tablets or capsules -- swallow them whole. Chewable aspirin tablets may be chewed, crushed, or dissolved in a liquid.
- Aspirin should never be taken in place of other medications or treatments recommended by your doctor.
- Never take it with alcohol. That increases your chance of stomach bleeding.
Ask your doctor what other medicines you can take for pain relief or minor colds while you take aspirin. Read the labels of all pain relievers and cold products to make sure they’re aspirin-free. Other drugs with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may cause bleeding when taken with your regular aspirin therapy.
Before any surgery, dental procedure, or emergency treatment, tell the doctor or dentist that you’re taking aspirin. You might need to stop taking it for 5 to 7 days before your procedure.
However, don’t stop taking this medicine without first consulting with your doctor.
Who Shouldn't Take Aspirin?
- Children younger than age 18 who have or are recovering from a viral infection such as the flu or chickenpox
- Pregnant women (unless otherwise directed by your doctor)
- People about to have surgery
- Heavy drinkers
- Those with ulcers or any other bleeding problem
- Folks who take regular doses of other pain medications, such as ibuprofen (unless otherwise directed by your doctor)
- People allergic to aspirin
Talk with your doctor about whether aspirin might be a good idea for you.
Are There Side Effects?
Yes. Some common ones include:
Call your doctor if any of these become severe or do not go away.
Contact them right away if you have:
- Severe stomach pain or heartburn
- Serious nausea or vomiting
- Blood in the urine, stool, or vomit
- Any unusual bruising
- Heavy bleeding from cuts
- Black, tarry stools
- Coughing up blood
- Heavy menstrual bleeding or unexpected vaginal bleeding
- Vomit that looks like coffee grounds
- Facial swelling
- An asthma attack
- Ringing in the ears
- Severe headache
Aspirin Poisoning Treatment
Call 911 if the person is:
- Vomiting severely
- Agitated or lethargic
- Having convulsions
- Not breathing
For an overdose of aspirin:
- Call Poison Control at 800-222-1222 for instructions, even if there are no signs of poisoning.
- If possible, provide this information: all medications the person may have taken, how much the person may have taken, and when.
- For small amounts, you may need to watch the person carefully at home.
- For a larger amount, you may need to take the person to a hospital emergency department.
- Take the aspirin bottle to show the health care professional.
- At the hospital, health care professionals will check the level of aspirin in the blood and will do testing to determine the aspirin's toxic effect on the body. They may give activated charcoal or other medication to slow or prevent toxicity.
- They may also give IV fluids.